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Individuals with serious mental illnesses (SMI) or personality disorders (PD) have complex treatment needs and are at risk of adverse outcomes. Yet, little is known about the impact of comorbid SMI and PD on risk factors. This study used the Veterans Health Administration (VHA)’s corporate data warehouse (CDW) to assess the differences between those with and without a comorbid PD, as well as the prevalence and impact of PD diagnoses on high-intensity/emergency service utilization in VHA patients with a SMI diagnosis (schizophrenia spectrum disorders and bipolar spectrum disorders). In fiscal year 2018, 163,904 VHA patients had encounters that listed SMI diagnoses, including 9,216 patients who had encounters that listed PD diagnoses. Bivariate analyses and logistic regression were used to compare group characteristics and determine whether a PD diagnosis was associated with utilization of high-intensity care services. The SMI with no PD and SMI with comorbid PD (SMI–PD) groups differed in terms of demographic, medication, clinical, and service utilization characteristics, including that the SMI–PD group was 5.25 times more likely to have documented suicide risk and 4.73 times more likely to have documented behavioral risk. After controlling for multiple patient characteristics, patients in the SMI–PD group were 1.35 times more likely to have some emergency department (ED) utilization and 1.94 times more likely to have some inpatient mental health use. Having a diagnosed comorbid PD was associated with increased prevalence of medical and psychiatric problems. Findings suggest that patients with comorbid PDs have particularly high-treatment needs and may benefit from assessment of, and adapted treatments for, PDs.

Outreach to people with serious mental illness who are disengaged from treatment can facilitate return to care. However, little is known regarding what outreach strategies are effective. This mixed-methods evaluation assessed best practices for conducting outreach to Veterans with serious mental illness via the national Veterans Health Administration Re-Engaging Veterans with Serious Mental Illness program by comparing the strategies used by high-performing sites and low-performing sites. Quantitative data included the types and number of contact attempts used to reach Veterans. Qualitative data included interviews with clinicians from high-and low-performing sites. Results indicated making at least four contact attempts using methods of phone, certified letter, and next of kin differentiated high from low-performing facilities. Clinicians from high-performing sites also differed from low-performing sites in their expressed philosophy about outreach, demonstrated a broader array of strategies in attempting to contact Veterans, and described greater connections with others at their site, with clinicians around the country, and with national program resources. Implications of evaluation findings for outreach programs and research are discussed. Impact StatementThis study identified best practices for conducting outreach to Veterans with serious mental illness who were lost-to-Veterans Health Administration health care. Best practices include making at least four attempts to contact a Veteran using telephone, certified letter, and next of kin. Clinicians who were more successful at contacting Veterans and facilitating their return-to-health care demonstrated creativity, persistence, and described more connections to others within their medical center, clinicians around the country, and national program resources.

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